Activity measure post-acute care score for discharge outcomes is associated with prolonged venous transit on perfusion imaging in reperfused large vessel occlusion strokes.

Abstract

Activity Measure for Post-Acute Care (AM-PAC) score is used in discharge planning for patients with acute ischemic stroke from a large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT) is a binary, qualitative measure visually ascertained from computed tomography perfusion imaging time-to-maximum (Tmax) maps. PVT has been associated with unfavorable recovery and mortality. To assess the robustness of PVT by evaluating its association with AM-PAC. Consecutive adult patients with AIS-LVO treated successfully with reperfusion therapy were retrospectively reviewed. PVT+ is defined as Tmax <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>≥</mo></mrow> <annotation>$$ \ge $$</annotation></semantics> </math> 10 seconds timing on at least one of the following: superior sagittal sinus and/or torcula. PVT- lacks this in both regions. Primary outcome was favorable AM-PAC score, defined as having both Basic Mobility Score <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>≥</mo></mrow> <annotation>$$ \ge $$</annotation></semantics> </math> 17 and Daily Activity Score <math xmlns="http://www.w3.org/1998/Math/MathML"> <semantics><mrow><mo>≥</mo></mrow> <annotation>$$ \ge $$</annotation></semantics> </math> 19. Logistic regressions in unmatched and 1:1 propensity score-matched cohorts were performed. Among 121 patients, the median age was 72 (interquartile range, 64-81) years. Favorable AM-PAC scores occurred less often in PVT+ than PVT- patients (10.5% vs. 45.8%). PVT+ was associated with significantly reduced odds of favorable AM-PAC score in multivariable regressions (PVT+ vs. PVT- odds ratio [OR]: 0.11, 95% confidence interval [CI]: 0.03-0.48, p = .01); the significant association furthermore persisted in the matched cohort analysis (PVT+ vs. PVT- OR: 0.73, 95% CI: 0.60-0.88, p < .001). PVT+ is independently associated with lower odds of favorable AM-PAC scores at discharge. Logistically-consistent associations with short-term and long-term clinical outcomes augment our understanding of PVT and further establish the potential of this novel imaging parameter as an informative metric in clinical practice.